By: Smt. R.K.Madanavally, Member
Brief facts
The complainant is a policy holder under opposite party No.1 vide policy No.796922689.
The complainant had remitted Rs.44,142/- towards opposite party under 21 installments. Due to the financial crisis, he couldn't continue the policy and she demanded the amount which was already remitted by him. The opposite party informed her that they will repay only an amount in between 50% and 60%. She had got the bonus benefit of Rs.15000/- once in 4 years. Now the opposite party informed the complainant that the bonus amount of Rs.15,000/- will be deducted from the total amount ie the amount which came around in between 50% and 60%. According to her she is entitled for Rs.30,000/- the opposite party is not ready to pay the same and hence this complaint.
The policy was admitted by the opposite party in their written version. Other allegations were totally denied. The New Bima Gold Policy is for the period of 16 years and 15% of the sum assured under basic plan is payable as survival benefit in case of life assured surviving to the end of the specified duration provided in the policy is in full force by paying up to date premiums. Since the premium were paid up to 3/15 the opposite party had released the 1st survival benefit of Rs.15,000/-. According to opposite party No.1 the complainant had remitted Rs.42040/- as premium up to 3/15 and not Rs.44,142/-. The complainant is praying for return of premium plus interest. As per the policy, there is no provision for refund of premium paid.
The insurer collects premium from their policy holders on the condition that they will pay the sum assured under the policy when the life assured expired or the policy matures. So also all the characteristics of the policy were mentioned in the version. As per the above policy, the surrender value payable to the complainant is Rs.11954/-. No deficiency is committed by them and the complaint has to be dismissed with cost.
Now the issues arise for our consideration here in are;
(1) Whether the opposite party is deficient in service?
(2) If so relief and cost
Point No.1
The complainant produced documents which are marked as Ext. A1 to A7. Ext. A1 is the policy and Ext. A2 is the Bond Ext. A3(s) are the cash receipts 17 in Numbers. Ext. A4 is the premium reminder letter. Ext. A5 is the premium intimation letter. Ext. A6 and A7 are the Adhar card and ID card of the complainant respectively. So also Ext. B1 to B4 were marked on the side of the opposite party. Ext. B1 is the terms and conditions of the policy, Ext. B2 is the proposal form. Ext. B3 is the Agents confidential cum moral Hazard receipt and Ext. B4 is the surrender value.
On perusal of the Affidavit and documents produced by the complainant it is admittedly true that the complainant had not remitted the entire premiums. She had made payment only from 17/3/10 to March 2015. The complainant and opposite party are bound to obey the policy since it is a contract. Though she had made payment only for a period of 5 years, in the 4th year she had accepted Rs.15000/- from the opposite party. Now the reason for the non remittance is the financial difficulties on the part of the complainant. The complaint has no case that the opposite party or its agent cheated/misled her at the time of signing the proposal form. Since the complainant is not ready to continue the policy, opposite party has to make a reasonable payment. Denial of a reasonable amount is deficiency in service. More over they have no right to deduct the bonus amount from the total amount.
It is under stood that the opposite party was acting on the basis of the policy. They had paid 15000/- Rupees as a part of sum assured. Now they are ready to pay the surrender value of Rs.11954/- to the complainant. Then the complainant will get a total sum of Rs.26954/-. (Rs.15000 + 11954). At the same time the complainant had already paid Rs.42040/-
The total amount admitted by the opposite party is 42040/-. We feel that it is not proper to direct the opposite party to pay the entire remitted amount to the complainant since she is a defaulter. She should also suffer some loss. Paying an additional amount of Rs. 10,000/- to the complainant will meet the ends of justice
The 1st point is answered accordingly.
Point No.2
In view of the above discussion we are passing the following orders.
(1) The opposite party shall pay the surrender value of Rs.11954/- to the complainant(if it is not paid so far)
(2) The opposite party shall further pay Rs.10000/- to the complainant.
(3) No order as to cost and compensation.
Dated this 16th day of April, 2016
A.A.VIJAYAN, PRESIDENT
R.K.MADANAVALLY , MEMBER
MINI MATHEW, MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1to A7
Ext.A1 : Policy
Ext.A2 : renewal premium receipt
Ext A3 : Cash receipts 17 in November
Ext A4 : Premium reminder letter
Ext A5 : Premium intimation letter
Ext A6 : Photo copy of Adhar card
Ext A7 : Photo copy of ID card
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Ext. B1 to B4
Ext.B1 : Photo copy of policy
Ext.B2 : Proposal form
Ext.B3 : Agents confidential report.
Ext.B4 : Surrender value
A.A.VIJAYAN, PRESIDENT
R.K.MADANAVALLY , MEMBER
MINI MATHEW, MEMBER
